As Egypt continues to grapple with the proliferation of the hepatitis C virus, fresh treatment, prevention and market access pathways are now being applied.
Given the severity of Egypt’s hepatitis C epidemic, the national campaign against viral hepatitis remains Egypt’s top healthcare priority. According to Roche’s regional general manager, Ehab Yousef, hepatitis constitutes the therapeutic category with the largest budget within the Ministry of Health and the Health Insurance Organization, and Minister of Health Ahmed Emad El-Din Rady affirms that one of his primary tasks as minister relates to “driving and strengthening the national campaign against the hepatitis C virus, which is has reached epidemic proportions in the country.” Moreover, as Abbvie’s Amjad Laimoun indicates, “the level of the government’s commitment is very strong, as fighting Hepatitis C Virus (HCV) is the president’s highest healthcare priority; in fact, the president has been involved in several initiatives himself.”
Former Minister of Health, Adel Adawy, explains that he has “always maintained the strong belief that treatment alone is not enough, given that this particular epidemic arose due to a lack of preventative protocols.” Today, the majority of new Egyptian hepatitis C infections occur within medical facilities, and Adawy regards his introduction of the new Action Plan for Prevention Care and Treatment as a major legacy of his administration, comprising a holistic and comprehensive approach that encompassed seven mutually reinforcing pillars: infection control, injection safety, blood safety, screening methodology, communication strategy, awareness campaign, and scientific research. It is with this plan that he hopes Egypt can soon “reach a tipping point where the number of patients undergoing treatment surpasses than becoming newly infected.”
However, with the arrival of new generation of anti-viral medications over the last two years, such as Sovaldi (sofosbuvir), the treatment paradigm for hepatitis C in Egypt and around the world has been drastically altered. Adawy recounts how his second day as minister, “I had the chance to meet Mr. Samuel, the vice president of Gilead, and this was in March 2014 just three months after the FDA had approved Sovaldi. From that first day we began discussions over how we could take a significant step towards solving the HCV epidemic by bringing Sovaldi to Egypt at an affordable price… The result was a proposal for a governmental purchase program that he took to the board of Gilead, and on July 2nd 2014 he signed a formal memorandum of understanding. Adawy then explains that just “three months later, in October 2014, the first patient was treated. This is an astounding feat for Egypt as having a product registered, priced, and brought to market in less than four months is something that had never happened before and will likely never happen again.”
As per this agreement, Sovaldi was made available in Egypt at just one percent of the US retail price (and then later decreased), and Adawy explains that to “prevent patients from selling their medications on the black market… the National Committee for Control of Viral Hepatitis had to establish treatment centers where doctors could watch the patients take the first pill of their monthly dose, and then return that exact bottle at the end of the month.” Significant investments were also required to deal with the sheer volume of patients who initially sought treatment, as not all could be treated immediately due to funding constraints, and thus a web based application system had to be established such that patients could be screened and then treated based on the severity of their infections.
This treatment program run by the National Committee for Conrol of Viral Hepatitis was on track to treat more than 180,000 patients in 2015 according to Laimoun, with an additional 30,000 treated by the Health Insurance Organization, while “between 300,000 and 500,000 patients need to be treated [per year]… to reduce HCV prevalence in Egypt to levels similar to those in Europe or the US.” Adawy highlights that “one challenge is that while we have a plan for treating patients in the public sector, the many patients who are treated in the private sector are not incorporated into our plans for monitoring,” and as such it is unclear how much further treatment capacity must be built to put the country on track to eliminating the overall epidemic.
However, while exact data on private sector treatment volumes remains unavailable, it is clear that facilitating private sector treatment is a key feature of the government’s strategy to manage hepatitis C. Saad Ibrahim, general manager for Marcyrl’s scientific office, explains “the original TRIPs agreement allows governments to license companies to product generic versions of patent protected products; Egypt has exercised this right for sofosbuvir and other molecules used to treat Hepatitis C due to the scale of this epidemic.” Since his September 2015 inauguration Minister El-Din Rady has made it his “goal to reduce the cost of treatment for hepatitis C as much as possible,” which has helped to drive strong treatment numbers; the minister also highlights that a recent (small sample size) demographic health survey saw the incidence of HCV fall from 10 percent in 2010 to just 7 percent by the end of 2015.